Abstract

Aim: To examine neighbourhood income differences in deaths amenable to medical care and public health over a 25-year period after
the establishment of universal insurance for doctors and hospital services in Canada.

Methods: Data for census metropolitan areas were obtained from the Canadian Mortality Database and population censuses for the years
1971, 1986, 1991 and 1996. Deaths amenable to medical care, amenable to public health, from ischaemic heart disease and from
other causes were considered. Data on deaths were grouped into neighbourhood income quintiles on the basis of the census tract
percentage of population below Canada’s low-income cut-offs.

Results: From 1971 to 1996, differences between the richest and poorest quintiles in age-standardised expected years of life lost
amenable to medical care decreased 60% (p<0.001) in men and 78% (p<0.001) in women, those amenable to public health increased
0.7% (p = 0.94) in men and 20% (p = 0.55) in women, those lost from ischaemic heart disease decreased 58% in men and 38% in
women, and from other causes decreased 15% in men and 9% in women. Changes in the age-standardised expected years of life
lost difference for deaths amenable to medical care were significantly larger than those for deaths amenable to public health
or other causes for both men and women (p<0.001).

Conclusions: Reductions in rates of deaths amenable to medical care made the largest contribution to narrowing socioeconomic mortality
disparities. Continuing disparities in mortality from causes amenable to public health suggest that public health initiatives
have a potentially important, but yet unrealised, role in further reducing mortality disparities in Canada.

Footnotes

Funding: The following organisations supported research and administrative costs of this study; these organisations were not
involved in the design or conduct of this study and did not participate in data collection, analysis or interpretation: Population
and Public Health Branch, Health Canada; Canadian Population Health Institute, Canadian Institute for Health Information;
Canadian Population Health Initiative; and Centre for Global Health, Institute for Population Health, University of Ottawa.

Competing interests: None declared.

PDJ had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of
the data analysis. Below is a summary of the authors’ contributions to this manuscript: